Virginia Medicare Supplement Plans (Medigap)
Virginia Medicare Supplement plans were designed to complement your Medicare Benefits. A Medicare Supplement plan picks up what is not covered by your Medicare Part A and B.
Think of it this way, a Medicare Supplement Plan will fill the holes left by your Original Medicare. Deductibles, coinsurance and copays fall into this category.The amount of additional coverage you have will depend on the Medicare Supplement plan that you choose.
Medigap plans are the same as Medicare Supplement plans. Same meaning, different wording. Medicare Supplement options are broken down into “Plans”. These plans are sold by private insurance companies and are named using letters. Benefits available to Medicare Beneficiaries are broken into parts and plans.
Virginia Medicare Benefits and Health Plans Explained
- Part A provides hospital benefits (hospital stays, skilled nursing facility, etc.). The 2018 annual deductible for Part A is $1340.
- Part B provides medical coverage (doctor visits, durable medical equipment, etc.) The annual deductible for Part B is $183.
- Part C is a Medicare Advantage plan. These plans take the place of your Medicare Part A & B. Some even include prescription drug coverage. The coverage is provided by a private insurance company, and benefits are combined under one plan which typically has a deductible higher than medicare, and out of pocket maximums can be as high as $5,000 or more. These plans are usually cheap and leave the insured person with high out of pockets expenses.
- Part D provides prescription drug coverage, as known as PDP. Prescription drug coverage is never included in a medical plan and will always be purchased separately.
Virginia Medicare Supplement Plans
Plan F provides the “fullest” coverage. Plan F pays everything not covered by original Medicare. It picks up the original medicare deductibles and pays the 20% coinsurance. All costs that would normally be passed to the medicare beneficiary.
Medicare Plan G covers everything except the $183 per year Medicare Part B deductible. The savings accumulated by the lower monthly premiums could easily cover the deductible amount. Explaining why this is a favorite among medicare beneficiaries.
Plan N pays 100% coinsurance after the $183 deductible and the insured has a $20 copayment per office visit and a $50 copayment for emergency room visits.
The most comprehensive health care option is Original Medicare (Part A and B) along with a Prescription Drug Plan (Part D) and a Medicare Supplement (ie: Plan F, G or N).
What Benefits does Medicare Cover in Virginia
Hospital stays are covered for up to 90 days. The deductible applies and the insured person may be responsible for up to 20% coinsurance. National average for hospital costs per night are around $10,000 according to the Agency for Healthcare Research and Quality.
Skilled Nursing Facilities are covered for up to 100 days and leave the patient with the deductible and coinsurance.
Durable Medical Equipment is covered by Medicare, the Part B deductible and coinsurance will apply. Most medical equipment with costs in excess of $700 could be billed over the course of 13 months as a rental.
Therefore, you could incur the Original Medicare deductible twice (for two policy years) and you will be responsible for paying 20% coinsurance every month.
It becomes apparent that Medicare has some holes and the most effective way to fill those coverage gaps is with a Medicare Supplement Plan.
How to Enroll in Medical Supplement Plans in Virginia
Enrolling in a Medicare Supplement Plan is easy. You must be at least 65 years old and enrolled in Medicare Part B. Enrolling in Part B as soon as you are eligible will avoid the Part B late penalty imposed by Medicare.
You can learn about the Part B late penalty by clicking here.
Medicare Eligibility in Virginia for the Disabled, Under 65
When receiving benefits from Social Security or certain disability benefits from the Railroad Retirement Benefits for 24 months, you automatically get Medicare Part A and Part B.
When to Enroll in Virginia Medicare Supplement Plans
Open Enrollment Period (OEP) This is the best time to Enroll into a Medicare Supplement plan. It starts the 1st day of the month you are at least 65 years old and your Medicare Part B has become effective.
For example, if your birthday was July 31st and your Medicare Part B effective date was September 5th, then your OEP begins October 1st. The Open Enrollment Period is effective for 6 months and during this time your you are not subject to medical underwriting.
Special Enrollment Period (SEP) is available for 60 days following an event. An event would be defined as moving or losing coverage through your employer or your spouse’s employer. Furthermore, depending on your circumstances, you may be in a Guaranteed Issue period.
Guaranteed Issue means you will NOT be turned down due to current or past medical conditions. Enrolling during the GI period also gives peace of mind that you will not pay more in premium based on your medical history.
Even if you missed the Open Enrollment Period, you can still enroll in a Medigap Plan. Through a Special Enrollment Period (SEP), Initial Enrollment Period (IEP) and General Enrollment Period (GEP) you may able to save money by enrolling in a Medicare Supplement (Medigap) plan.
Medicare Supplement Costs in Virginia
Premium costs are determined by the insurance companies and not the state of Virginia. The price is based on variables such as age, gender and location. For example, the cost of a plan will not be same in Ashburn as it is in Virginia Beach.
Each carrier uses 1 of 3 rating methods.:
- Community Rated (everyone pays the same amount)
- Issue Age Rated (premiums based on your age when you buy your policy)
- Attained Age Rated (higher premiums as you get older)
The benefits provided for Medicare Supplement Plans do not vary. Therefore, Plan F will have the same benefits no matter what insurance company is listed on the card you carry. The difference is the cost.
Medicare beneficiaries in Ashburn that have enrolled in Medigap Plan F will have the same benefits as those living in Virginia Beach and enrolled in Medigap Plan F. However, they may not pay the same monthly premium.
Plan F in Virginia
Plan F provides the most coverage. It does cost a little more, but for that cost all Medicare covered medical expenses left to you after Medicare pays it’s portion will be picked up by your private insurer. Therefore, you pay your monthly premium and nothing else.
Virginia Plan G
Plan G is an affordable option with great coverage. With this option, you are still responsible for the yearly Part B deductible of $183, but you save over $350 in annual premium.
Furthermore, after you meet the deductible, everything not paid by your Original Medicare is paid by your private insurance company. Therefore, this is a frugal option, allowing medicare beneficiaries to save the most money and get the coverage they demand.
Plan N in Virginia
Plan N is a lower cost Medigap option. It provides the broad coverage expected from a Medicare Supplement Plan without the same monthly premium. The monthly premium in Virginia Beach averages $80.
The medicare beneficiary will be responsible for the Part B $183 annual deductible, office visits have a $20 copayment and the emergency room copayment is $50. However, Plan N does not cover state excess charges which may be applicable.
Virginia Medicare Advantage Plans
Medicare Advantage Plans replace your Original Medicare with a different plan entirely. You forfeit the yearly medicare deductibles and 20% coinsurance option. Instead you will be bound to use a limited HMO or PPO.
You cannot utilize providers outside the network without being penalized. The low premium costs make these plans look appealing, however the maximum out of pocket is usually around $5,000.
For example, a Medigap Plan F in Virginia Beach costs about $1600 per year. Everything else is covered. However, a Medicare Advantage Plan can leave the insured with expenses exceeding $5000.
Virginia Prescription Drug Plans (PDP) for Medicare
Prescription Drugs are not covered by any of the aforementioned medical plans. Therefore, you’ll need to purchase a separate PDP or face a penalty.
Prescription Drug Plans are not all alike. Therefore, you’ll need to rely on your insurance agent to guide you into a plan that will best fit your individual needs.
You have a 7 month enrollment period from the time you become eligible for Medicare. Additionally, if you do not enroll in a qualifying PDP, you will incur a penalty of approximately 1% for every month not enrolled. This penalty will never go away.
Get Help Choosing your Medigap Plan
It’s best for get help from a Medicare Supplement broker licensed in Virginia. Most of all, someone you can trust to guide you through your options and give you the facts.
Fill out the quote form provided on the page and/ or call. We can help with all Medicare options, including Medigap, Prescription Drug Plans and Medicare Advantage Plans.
Virginia Medicare Resources
If you are on a fixed income, you may be able to get extra help with the high cost of health care. In addition, a Medicare Savings Program can pay deductibles, coinsurance and other costs that aren’t ordinarily covered.
Virginia Medicare FAQs
Question: How do you get on Medicare Hospice in Virginia?
Answer: You must be eligible for Medicare Part A, a doctor and the hospice medical director must certify that you are terminally ill and have 6 months or less to live.
Question: Did Virginia expand Medicare?
Answer: Virginia is considering expansion.
Question: Are Mental Health services covered by Medicare in Virginia?
Answer: Yes. Part B covers outpatient mental health services at a doctor or other health care provider’s office or hospital outpatient department.